Skip to main content
SpringerLink
Log in

Endoscopic Treatments of GERD

  • Esophagus (PG Iyer, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

Purpose of review

Endoscopic therapies for gastroesophageal reflux disease (GERD) are minimally invasive techniques which fill the gap between the medical therapy with proton pump inhibitors (PPIs) and surgical fundoplication. The main endoscopic therapies currently available in the USA are transoral incisionless fundoplication (TIF) using EsophyX device or less commonly, Medigus Ultrasonic Surgical Endostapler, and radiofrequency energy delivery to lower esophageal sphincter using Stretta device. Our aim was to examine the available evidence for these therapies.

Recent findings

Consistent evidence for subjective improvement is available for fundoplication using EsophyX and Stretta, but improvement in objective parameters for GERD is not seen or evaluated in all the studies. There is a reduction in long-term efficacy seen with TIF and also to a lesser extent with Stretta.

Summary

Endoscopic therapies do not replace surgical fundoplication and therefore are useful in patients with breakthrough symptoms on PPI such as regurgitation or those reluctant to take long-term PPI. An ideal patient is one who has symptoms and objective evidence of GERD such as abnormal pH study or erosive esophagitis without any significant anatomic distortion such as a hiatal hernia. Since these are endoluminal procedures, they do not address the hiatal hernia reduction or repair of crural defect. Adequate training in the technique and careful patient selection are essential prior to embarking on these procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

EAE:

Esophageal acid exposure

GERD:

Gastroesophageal reflux disease

GERD-HRQL:

Gastroesophageal reflux disease-health-related quality of life

LES:

Lower esophageal sphincter

MUSE:

Medigus Ultrasonic Surgical Endostapler

PPI:

Proton pump inhibitor

RCT:

Randomized controlled trial

SCJ:

Squamocolumnar junction

TIF:

Transoral incisionless fundoplication

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Richter JE. The patient with refractory gastroesophageal reflux disease. Dis Esophagus. 2006;19:443–7. https://doi.org/10.1111/j.1442-2050.2006.00619.x.

    Article  CAS  PubMed  Google Scholar 

  2. Vaezi MF, Yang YX, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology. 2017;153:35–48. https://doi.org/10.1053/j.gastro.2017.04.047.

    Article  CAS  PubMed  Google Scholar 

  3. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28. https://doi.org/10.1038/ajg.2012.444.

    Article  PubMed  Google Scholar 

  4. •• Pearl J, Pauli E, Dunkin B, Stefanidis D. SAGES endoluminal treatments for GERD. Surg Endosc. 2017;3:3783–90. https://doi.org/10.1007/s00464-017-5639-1. This article represents the 2017 SAGES review on “endoluminal treatments for GERD.”

    Article  Google Scholar 

  5. •• ASGE Technology Committee, Thosani N, Goodman A, Manfredi M, Navaneethan U, Parsi MA, et al. Endoscopic anti-reflux devices [with videos]. Gastrointest Endosc. 2017;86:931–48. https://doi.org/10.1016/j.gie.2017.08.001. This article represents the 2017 ASGE review on “endoscopic anti-reflux devices.”

    Article  Google Scholar 

  6. Auyang ED, Carter P, Rauth T, Fanelli RD, SAGES Guidelines Committee. SAGES clinical spotlight review: endoluminal treatments for gastroesophageal reflux disease [GERD]. Surg Endosc. 2013;27:2658–72. https://doi.org/10.1007/s00464-013-3010-8.

    Article  PubMed  Google Scholar 

  7. Fass R. An overview of transoral incisionless fundoplication and magnetic sphincter augmentation for GERD. Gastroenterol Hepatol. 2017;13:50–2.

    Google Scholar 

  8. Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr. 1956;86(Suppl 20):590–2. German

  9. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991;1:138–43.

    CAS  PubMed  Google Scholar 

  10. Ebright MI, Sridhar P, Litle VR, Narsule CK, Daly BD, Fernando HC. Endoscopic fundoplication: effectiveness for controlling symptoms of gastroesophageal reflux disease. Innovations [Phila]. 2017;12:180–5. https://doi.org/10.1097/IMI.0000000000000351.

    Google Scholar 

  11. Frazzoni M, Conigliaro R, Manta R, Melotti G. Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD. Aliment Pharmacol Ther. 2011;34:67–75. https://doi.org/10.1111/j.1365-2036.2011.04677.x.

    Article  CAS  PubMed  Google Scholar 

  12. Testoni PA, Vailati C, Testoni S, Corsetti M. Transoral incisionless fundoplication [TIF 2.0] with EsophyX for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc. 2012;26:1425–35. https://doi.org/10.1007/s00464-011-2050-1.

    Article  PubMed  Google Scholar 

  13. Hunter JG, Kahrilas PJ, Bell RCW, Wilson EB, Trad KS, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015;148:324–33. https://doi.org/10.1053/j.gastro.2014.10.009.

    Article  CAS  PubMed  Google Scholar 

  14. Trad KS, Fox MA, Simoni G, Shughoury AB, Mavrelis PG, et al. Transoral fundoplication offers durable symptom control for chronic GERD: 3-year report from the TEMPO randomized trial with a crossover arm. Surg Endosc. 2017;31:2498–508. https://doi.org/10.1007/s00464-016-5252-8.

    Article  PubMed  Google Scholar 

  15. Wendling MR, Melvin WS, Perry KA. Impact of transoral incisionless fundoplication [TIF] on subjective and objective GERD indices: a systematic review of the published literature. Surg Endosc. 2013;27:3754–61. https://doi.org/10.1007/s00464-013-2961-0.

    Article  PubMed  Google Scholar 

  16. Huang X, Chen S, Zhao H, Zeng X, Lian J, et al. Efficacy of transoral incisionless fundoplication [TIF] for the treatment of GERD: a systematic review with meta-analysis. Surgical Endoscopy. 2017;31:1032–44. https://doi.org/10.1007/s00464-016-5111-7.

    Article  PubMed  Google Scholar 

  17. Toomey P, Teta A, Patel K, Ross S, Sukharamwala P, Rosemurgy AS. Transoral incisionless fundoplication: is it as safe and efficacious as a Nissen or Toupet fundoplication? Am Surg. 2014;80:860–7.

    PubMed  Google Scholar 

  18. Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx [Tif 2.0] and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. Surg Endosc. 2015;29:2770–80. https://doi.org/10.1007/s00464-014-4008-6.

    Article  PubMed  Google Scholar 

  19. Stefanidis G, Viazis N, Kotsikoros N, Tsoukalas N, Lala E, et al. Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy. Dis Esophagus. 2017;30:1–8. https://doi.org/10.1111/dote.12525.

    PubMed  Google Scholar 

  20. Svoboda P, Kantorová I, Kozumplík L, Scheer P, Radvan M, et al. Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure. Hepatogastroenterology. 2011;58:1208–13. https://doi.org/10.5754/hge10108.

    Article  PubMed  Google Scholar 

  21. Håkansson B, Montgomery M, Cadiere GB, Rajan A, Bruley des Varannes S, et al. Randomized clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther. 2015;42:1261–70. https://doi.org/10.1111/apt.13427.

    Article  PubMed  Google Scholar 

  22. Triadafilopoulos G. Stretta: a valuable endoscopic treatment modality for gastroesophageal reflux disease. World J Gastroenterol. 2014;20:7730–8. https://doi.org/10.3748/wjg.v20.i24.7730.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brar TS, Draganov PV, Yang D. Endoluminal therapy for gastroesophageal reflux disease: in between the pill and the knife? Dig Dis Sci. 2017;62:16–25. https://doi.org/10.1007/s10620-016-4355-3.

    Article  CAS  PubMed  Google Scholar 

  24. Noar M, Squires P, Noar E, Lee M. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc. 2014;28:2323–33. https://doi.org/10.1007/s00464-014-3461-6.

    Article  PubMed  Google Scholar 

  25. Richards WO, Houston HL, Torquati A, Khaitan L, Holzman MD, et al. Paradigm shift in the management of gastroesophageal reflux disease. Ann Surg. 2003;237:638–49.

    PubMed  PubMed Central  Google Scholar 

  26. Kahrilas PJ. Radiofrequency energy treatment of GERD. Gastroenterology. 2003;125:970–3.

    Article  PubMed  Google Scholar 

  27. Arts J, Bisschops R, Blondeau K, Farré R, Vos R, et al. A double-blind sham-controlled study of the effect of radiofrequency energy on symptoms and distensibility of the gastro-esophageal junction in GERD. Am J Gastroenterol. 2012;107:222–30. https://doi.org/10.1038/ajg.2011.395.

    Article  CAS  PubMed  Google Scholar 

  28. Noar M, Squires P, Khan S. Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort. Surg Endosc. 2017;31:2854–62. https://doi.org/10.1007/s00464-016-5296-9.

    Article  PubMed  Google Scholar 

  29. Corley DA, Katz P, Wo JM, Stefan A, Patti M, et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology. 2003;125:668–76.

    Article  PubMed  Google Scholar 

  30. Coron E, Sebille V, Cadiot G, Zerbib F, Ducrotte P, et al. Consortium de Recherche Indépendant sur le Traitement et L’exploration du Reflux Gastro-oesophagien et de L’endobrachyoesophage [CRITERE]. Clinical trial: radiofrequency energy delivery in proton pump inhibitor-dependent gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther. 2008;28:1147–58. https://doi.org/10.1111/j.1365-2036.2008.03790.x.

    Article  CAS  PubMed  Google Scholar 

  31. Aziz AM, El-Khayat HR, Sadek A, Mattar SG, McNulty G, et al. A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:818–25. https://doi.org/10.1007/s00464-009-0671-4.

    Article  PubMed  Google Scholar 

  32. Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 2012;22:283–8. https://doi.org/10.1097/SLE.0b013e3182582e92.

    Article  PubMed  Google Scholar 

  33. Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13:1058–67. https://doi.org/10.1016/j.cgh.2014.10.013.

    Article  PubMed  Google Scholar 

  34. Dughera L, Rotondano G, De Cento M, Cassolino P, Cisarò F. Durability of Stretta radiofrequency treatment for GERD: results of an 8-year follow-up. Gastroenterol Res Pract. 2014;2014:531907. https://doi.org/10.1155/2014/531907.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zacherl J, Roy-Shapira A, Bonavina L, Bapaye A, Kiesslich R, Schoppmann SF, et al. Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler [MUSETM] for gastroesophageal reflux disease: 6-month results from a multicenter prospective trial. Surg Endosc. 2015;29:220–9. https://doi.org/10.1007/s00464-014-3731-3.

    Article  PubMed  Google Scholar 

  36. Kim HJ, Kwon CI, Kessler WR, Selzer DJ, McNulty G, et al. Long-term follow-up results of endoscopic treatment of gastroesophageal reflux disease with the MUSETM endoscopic stapling device. Surg Endosc. 2016;30:3402–8. https://doi.org/10.1007/s00464-015-4622-y.

    Article  PubMed  Google Scholar 

  37. Roy-Shapira A, Bapaye A, Date S, Pujari R, Dorwat S. Trans-oral anterior fundoplication: 5-year follow-up of pilot study. Surg Endosc. 2015;29:3717–21. https://doi.org/10.1007/s00464-015-4142-9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Danalioglu A, Cipe G, Toydemir T, Kocaman O, Ince AT, et al. Endoscopic stapling in comparison to laparoscopic fundoplication for the treatment of gastroesophageal reflux disease. Dig Endosc. 2014;26:37–42. https://doi.org/10.1111/den.12081.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    Carol Rouphael MD

  2. Esophageal Center, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, 44195, USA

    Ruthvik Padival MD, Madhusudhan R. Sanaka MD & Prashanthi N. Thota MD

Authors
  1. Carol Rouphael MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruthvik Padival MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madhusudhan R. Sanaka MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prashanthi N. Thota MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prashanthi N. Thota MD.

Ethics declarations

Conflict of interest

Carol Rouphael declares that she has no conflict of interest. Ruthvik Padival declares that she has no conflict of interest. Madhusudhan R. Sanaka declares that he has no conflict of interest. Prashanthi N. Thota declares that she has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Carol Rouphael and Ruthvik Padival are co-first authors

This article is part of the Topical Collection on Esophagus

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rouphael, C., Padival, R., Sanaka, M.R. et al. Endoscopic Treatments of GERD. Curr Treat Options Gastro 16, 58–71 (2018). https://doi.org/10.1007/s11938-018-0170-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-018-0170-6

Keywords

Search

Navigation